Cases reported "Hypertension, Portal"

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1/18. color Doppler sonography in the diagnosis of neonatal intrahepatic portosystemic shunts.

    Intrahepatic portosystemic shunts are infrequent in children. We report 3 cases of neonates who presented with jaundice during the first month of life. color Doppler sonography in the first 2 cases showed direct communication between the right portal and hepatic veins. Both infants were asymptomatic, and the shunts disappeared spontaneously. The third case involved several shunts and an aberrant medial portal vein. This patient developed heart failure and died after surgery. color Doppler sonography was useful in the diagnosis and follow-up of the shunts in all 3 cases.
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2/18. Trans-anastomotic porto-portal varices in patients with gastrointestinal haemorrhage.

    AIM: Porto-portal varices are commonly seen in patients with segmental extra-hepatic portal hypertension and develop to provide a collateral circulation around an area of portal venous obstruction. It is not well recognized that such communications may also develop across surgical anastomoses and be the source of gastrointestinal haemorrhage. The possible mode of development of such communications has not been previously discussed. MATERIALS AND methods: Over a 3-year period between 1995 and 1998, porto-portal varices were demonstrated across surgical anastomoses in four patients who were referred for the investigation of acute (two), acute-on-chronic (one) and chronic gastrointestinal bleeding (one). Their medical notes and the findings at angiography were reviewed. RESULTS: Three patients had segmental portal hypertension due to extra-hepatic portal vein (one) or superior mesenteric vein (two) stenosis/occlusion. One patient had mild portal hypertension due to hepatic fibrosis secondary to congenital biliary atresia. At angiography all patients were shown to have varices crossing previous surgical anastomoses. These varices were presumed to be the cause of bleeding in three of the four patients; the site of bleeding in the fourth individual was not determined. CONCLUSIONS: Trans-anastomotic porto-portal varices are rare. They develop in the presence of extra-hepatic portal hypertension and presumably arise within peri-anastomotic inflammatory tissue. Such varices may be difficult to manage and their prognosis is poor when bleeding occurs.
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3/18. Idiopathic hepatic arterio-portal fistula: report of one case.

    Hepatic arterio-portal fistula is a rare cause of portal hypertension in children; it is an abnormal communication of hepatic artery and portal venous system, the most common causes being trauma or malignancy. There were only 11 cases reported in English literature and were not ever reported in taiwan. We report a 9-year old boy with idiopathic hepatic arterio-portal fistula presented as intractable hematemesis due to esophageal and gastric varices. He had received sclerotherapy twice, and Sugiura operation (resection of the lower part of esophagus, devasculization of the stomach and splenectomy). Idiopathic hepatic arterio-portal fistula was found in angiography examination and the esophageal and gastric varices disappeared after transarterial embolization (TAE). We conclude that angiography is the golden diagnostic method for portal hypertension when the etiology is hepatic arterio-portal fistula and TAE will provide immediately therapy.
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4/18. Sonographic evaluation of portal hypertension in children.

    Portal hypertension, an expected consequence of cirrhosis, often has an insidious course in children. A noninvasive technique using abdominal sonography has been previously employed by several investigators as a means of diagnosing this condition. Their technique involves sonographically measuring the diameter of the lesser omentum, which increases as a result of engorged collaterals. In this communication, the method is successfully employed in two children, an infant in whom cirrhosis developed who eventually died from acquired immunodeficiency syndrome, and one whose portal hypertension was relieved after orthotopic liver transplantation. Although successful in these two instances, the theoretical basis on which this technique is based is critically evaluated. Anatomical relationships are reviewed that would caution sonographers who attempt to duplicate these studies. Modifications of the technique that will minimize potential false positive results are also discussed.
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5/18. arteriovenous fistula and portal hypertension secondary to islet-cell tumor of the pancreas.

    A case of portal hypertension secondary to an arteriovenous fistula in a pancreatic tumor is presented. Recurrent gastrointestinal hemorrhage prompted endoscopy which revealed esophageal varices and an abnormal papilla of Vater. ultrasonography and arteriography were instrumental in demonstrating the nature of the pathological process. In this situation portal hypertension resulted from increased portal venous flow rather than portal obstruction. Correction must include obliteration of systemic arterial to portal venous communication.
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6/18. Transhepatic embolization of superior mesenteric varices in portal hypertension.

    A 49-year-old woman with a history of excessive consumption of alcohol experienced lower-intestinal bleeding 2 years after undergoing a total abdominal hysterectomy and salpingo-oophorectomy because of carcinoma of the cervix. Mesenteric arteriograms showed large, focal varices in the ileum, hepatofugal blood flow, and an abnormal communication between these varices and the right ovarian vein. Percutaneous transhepatic embolization of these varices with absorbable, gelatin sponge (Gelfoam) and coils was successful in stopping the intestinal bleeding.
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7/18. Clinical utility of pulsed Doppler flowmetry in patients with portal hypertension.

    The recently developed Doppler flowmetry system that consists of an electronic sector and a pulsed Doppler flowmeter, is capable of determining the direction of blood flow in large veins visible by ultrasonography and measuring blood flow. It is noninvasive and can be performed in patients on ambulatory basis at the time of routine ultrasound examination. In this communication, clinical utility of pulsed Doppler flowmetry was tested in 20 patients with portal hypertension. Doppler flowmetry proved useful in differential diagnosis of splenorenal shunt and cystic disease, diagnosis of arterioportal shunt, diagnosis of portal vein occlusion, demonstration of hepatofugal flow in the splenic vein, and prediction of esophageal varices by the demonstration of hepatofugal flow in an enlarged left gastric vein.
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8/18. Bleeding intestinal varices associated with portal hypertension and previous abdominal surgery.

    patients with portal hypertension may develop portasystemic communication in adhesions formed after earlier surgery. This condition causes localized mesenteric and intestinal varices which may lead to significant gastrointestinal hemorrhage. Two patients with this disease spectrum are discussed. The recommended treatment was resection of the involved intestine and formation of a portacaval shunt to eliminate recurrence of the varices and subsequent hemorrhage.
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9/18. Congenital mesenteric arterio-portal fistula: report of a case.

    A male patient with an arterio-portal fistula resulting from a mesenteric arteriovenous malformation, who developed portal hypertension and liver cirrhosis, is presented herein. The malformation was considered to be congenital in origin and its location made any ablative surgical procedure impossible. Such alternative treatments as ligation of the afferent arteries, followed by transarterial embolization were therefore given, but both were unsuccessful. We also present a review of the literatures of mesenteric arteriovenous fistula. Radical surgical approach for this rare entity is proposed. The case reported here as related to mesenteric arteriovenous communications of congenital origin is the seventh such case published, and the first which was ever found to be located in the trunk of the superior mesenteric artery.
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10/18. A large inferior mesenteric-caval shunt via the internal iliac vein.

    A large portosystemic shunt between the inferior mesenteric vein and the right internal iliac vein in a 28-yr-old non-cirrhotic man is presented. This collateral was discovered by ultrasound done as a screening examination for gastrointestinal bleeding. The direct communication of the inferior mesenteric vein with the internal iliac vein was demonstrated by computed tomography and percutaneous transhepatic portography. Surgical ligation of the collateral, performed to prevent future portosystemic encephalopathy, resulted in reduction of serum ammonia level and cessation of long-standing hemorrhoidal bleeding.
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